| Business Information |
|
| Business Name:: |
|
| Fed Tax ID#:: |
|
| Business Address:: |
|
| .City:: |
|
| .State: |
|
| .Zip: |
|
| E-mail:: |
|
| Time in Business:: |
|
| Nature of Business:: |
|
| Business Type: |
CorporationLLC Proprietor Partnership |
| Business Phone:: |
|
| Lessee Information |
|
| First Name:: |
|
| Last Name:: |
|
| Social Security #:: |
|
| DOB:: |
|
| Home Address:: |
|
| City:: |
|
| State: |
|
| Zip:: |
|
| Home Phone:: |
|
| Bank Name:: |
|
| Account #:: |
|
| Vendor Information |
|
| Vendor Name:: |
|
| Vendor Address:: |
|
| Vendor City:: |
|
| State: |
|
| Vendor Zip:: |
|
| Equipment:: |
|
| Year:: |
|
| Make:: |
|
| Model:: |
|
| Equipment Cost:: |
|
| Residual:: |
|
| Comments:: |
|
| Authorization for credit release: |
CREDIT RELEASE: I hereby authorize the release of all credit information to and consent to the obtaining and use of my consumer credit report by any agency involved in securing funds for the above company, their designee, assigns/potential assigns at anytime, for obtaining credit, and applicable account maintenance. I understand that this information may be transmitted via Internet and/or fax machine. I consent to the photocopying of my drivers license for verification purposes in connection with a commercial lease transaction. I also consent to receiving unsolicited faxes and emails wherein the involved agency will advocate its services. The Patriot Act now requires Date of Birth. |